1. Implementation

2. Remember the overall goals! Strength & Balance exercises: 3 x week (rest days between), 30 mins PLUS Walking: If safe, 2 x week, 30 mins (or “snacks”)

3. Client Assessment Health AND Function: 1. chair stand test 2. four-test balance scale (original Otago assessments)p.25 WHY?

4. ASSESSMENT TOOLS Examples/to be agreed locally with falls services, and physiotherapists; Tinetti – Gait & Balance Tinetti – Gait & Balance Confidence in maintaining balance scale (ConfBal) Confidence in maintaining balance scale (ConfBal) Visual analogue Visual analogue Timed up & Go (3 meter) (TuG) Timed up & Go (3 meter) (TuG)

5. Original Research OEP Inclusion criteria –Inclusion: Living at home Living at home 65+ 65+ (most effective - >80, previous fall in past year) (most effective - >80, previous fall in past year) –Exclusion: Unable to walk around own home Unable to walk around own home Unable to understand Unable to understand Currently receiving physio Currently receiving physio

6. LLT Implementation Guidelines for Inclusion Suitability for inclusion assessed and confirmed by appropriate health professional. (Local protocols as agreed depending on leader/instructor skill sets); Living at home Living at home Able to walk/mobilise indoors without aid Able to walk/mobilise indoors without aid Able to independently walk outdoors (or with 1 stick) Able to independently walk outdoors (or with 1 stick) 65+ (most effective >80, previous fall in past year) 65+ (most effective >80, previous fall in past year) Able to rise from chair without assistance Able to rise from chair without assistance No contraindications to exercise No contraindications to exercise No co-morbidities (unless L3/L4 qualified instructor) No co-morbidities (unless L3/L4 qualified instructor)

7. LLT Implementation Guidelines for Exclusion Unable to walk around own home Unable to walk around own home Unable to understand Unable to understand Currently receiving physiotherapy Currently receiving physiotherapy 2 or more falls in past 6 months 2 or more falls in past 6 months Medical investigations pending Medical investigations pending Client has not been assessed as part of an agreed falls prevention service Client has not been assessed as part of an agreed falls prevention service

8. Outcome measure(s) Falls: Falls: –Stamped, addressed, monthly calendars filled in daily Compliance: Compliance: –Diary/calendar

9. Home visits Weeks 1,2,4,8 Month 6,12 Weeks 1,2,4,8 Month 6,12 30mins each 30mins each except week 1 = 1 hour What happens at each? What happens at each?

10. Progression Strength: Strength: –How? Increase ankle weight resistance –When? 2 sets of 10 reps (with sound technique) before progressing to next weight Balance: Balance: –How? Reduce support (recommended steps?) –When? Client can recover with legs not grab with arms

11. Equipment Instructor: Instructor: –Stopwatch –Table 4 (p.19) Reps/Progressions –Copies of exercise booklet (fill in reps) –Chart to record exercise prescription Client: Client: –Exercise booklet –Ankle cuff weights (1/2kg to start?) –Falls/Exercise calendar(s) –Sturdy, armless chair

12. Health & Safety 1 1. Venue (home and/or community venue) 2. Equipment 3. Service structure/OEP Leader support 4. Qualifications, and insurance Important considerations for delivering the OEP;

13. Health & Safety 2 1&2. Venue & Equipment – OEP Leaders should work with their line managers to ensure risk assessment of appropriate venues and equipment 3. Service structure – OEP Leaders should be working as part of a broader falls service whereby frailer and more complex patients can be referred to health professionals for input 4. Qualifications, and insurance – OEP Leaders should understand their parameters of practice and what populations they are able to lead exercise to

14. Telephone support Between home visits; Between home visits; months 3,4,5,7,8,9,10,11 OR Contact if no show at group sessions Contact if no show at group sessions

15. OEP Leader Assessment Complete TWO worksheets Complete TWO worksheets Practically lead FOUR of the OEP exercises in a role play situation Practically lead FOUR of the OEP exercises in a role play situation Complete a self evaluation of leading skills with peer feedback Complete a self evaluation of leading skills with peer feedback Submit a full session plan detailing ALL 24 of the OEP exercises Submit a full session plan detailing ALL 24 of the OEP exercises

16. OEP SESSION PLAN EXERCISENo. EXERCISE NAME REPETITIONS AND/OR TIME KEY SAFETY POINTS for effectiveness (NOT INSTRUCTIONS) PURPOSE E.G. ACTIVITIES OF DAILY LIVING (ADL) Front Knee Strengthener Build up to 10 reps - Sit back in chair so that back is supported *Posture (See above) – Reinforce - sit tall - Hands on Chair - Slow & Controlled move - Breathing - Full ROM but don ’ t lock knee Strengthen muscles at front of thigh and helps to improve balance. Helps: walking, getting up from a chair, stepping up or down, dressing.